BackgroundThe global incidence of spinal cord injury (SCI) is between 10 and 80 new cases per million people each year. This equates to between 250,000 and 500,000 injuries worldwide per year. In the United Kingdom, approximately 4400 people per year sustain an SCI. People with tetraplegia report upper limb function as their highest priority for improvement after SCI. Using immersive virtual reality (VR) headsets, physical rehabilitation exercises can be completed in engaging digital environments. Immersive VR therefore has the potential to increase the amount of therapy undertaken, leading to improvements in arm and hand function. There is little evidence supporting immersive VR as exercise in SCI, especially while patients with SCI are undergoing acute rehabilitation. In SCI research, co-design of new interventions is not a widely adopted approach, yet people with tetraplegia want to contribute with their expert knowledge on their experiences of SCI. ObjectiveThis study aims to explore the lived experiences of people with tetraplegia and specialist SCI therapists related to acute upper limb rehabilitation and identify design considerations for VR-based interventions targeting the upper limb. MethodsWe conducted 7 online focus groups using Microsoft Teams: 4 with people with tetraplegia (n=15; age range, 36-65 years) and 3 with occupational therapists and physiotherapists specializing in SCI rehabilitation (n=11). Participants were asked to discuss their experiences and expertise about acute SCI upper limb rehabilitation and their opinions and ideas on the use of VR for upper limb rehabilitation. The transcripts were analyzed using content analysis, enabling the proposition of design characteristics of a VR-based intervention for upper limb exercise. ResultsThe study identified 5 major themes describing the clinical features, treatment, and recovery of people with SCI during the acute stage of SCI, their motivations for participating in therapy, and suggestions for the design of a VR intervention in treating the upper limbs following SCI. ConclusionsThe themes identified in this study allow the elicitation of software requirements for a bespoke immersive VR platform for upper limb rehabilitation following SCI. They can also contribute to a better understanding of the advantages of using VR as an adjunct to upper limb rehabilitation. Additionally, participants used their expertise to suggest factors that would enable the development of a usable and effective intervention, as well as identifying potential pitfalls and software features to avoid during intervention development. These findings can be used to design accessible VR applications for use by people with tetraplegia and their therapists.

PURPOSE:To investigate the feasibility of an eight-week immersive virtual reality (VR) intervention using co-produced games for upper limb (UL) rehabilitation in people with multiple sclerosis (pwMS). METHODS:In this multicentre, two-armed randomised controlled feasibility study, participants were randomised to either an intervention group involving VR co-produced games, 30 min, twice/week, for eight weeks, or to a control group of usual care. A mixed methods approach was undertaken, collecting feasibility data, UL outcome measures, and conducting post-intervention interviews. RESULTS:Nineteen pwMS were recruited (intervention n = 11, control n = 8), with a recruitment rate of 3.2 participants/month. Adherence was good with 87% (±12%) session completed, with two dropouts both in the control group. Only minor adverse events were reported (n = 9), such as fatigue and UL pain. Participants reported high levels of satisfaction and good usability of VR games. Thematic analysis revealed participants enjoyed the distraction and atmospheres that immersive VR provided, and believed the games were fit for purpose with the majority of participants reporting improvements in their UL function. CONCLUSIONS:Immersive VR is feasible and safe for pwMS. Future work should refine recruitment strategies, develop VR games for long-term application and explore the clinical and cost effectiveness of this approach.

Advanced three-dimensional extended reality (XR) technologies are highly suitable for cultural heritage research and education. XR tools enable the creation of realistic virtual or augmented reality applications for curating and disseminating information about cultural artifacts and sites. Developing XR applications for cultural heritage requires interdisciplinary collaboration involving strong teamwork and soft skills to manage user requirements, system specifications, and design cycles. Given the diverse end-users, achieving high precision, accuracy, and efficiency in information management and user experience is crucial. Human–computer interaction (HCI) design and evaluation methods are essential for ensuring usability and return on investment. This article presents ten case studies of cultural heritage software projects, illustrating the interdisciplinary work between computer science and HCI design. Students from institutions such as the State University of New York (USA), Glasgow School of Art (UK), University of Granada (Spain), University of Málaga (Spain), Duy Tan University (Vietnam), Imperial College London (UK), Research University Institute of Communication & Computer Systems (Greece), Technical University of Košice (Slovakia), and Indiana University (USA) contributed to creating, assessing, and improving the usability of these diverse cultural heritage applications. The results include a structured typology of CH XR application scenarios, detailed insights into design and evaluation practices across ten international use cases, and a development framework that supports interdisciplinary collaboration and stakeholder integration in phygital cultural heritage projects.

Novel augmented reality headsets such as HoloLens can be used to overlay patient-specific virtual models of resection margins on the patient’s skin, providing surgeons with information not normally available in the operating room. For this to be useful, surgeons wearing the headset must be able to localise virtual models accurately. We measured the error with which users localise virtual models at different positions and distances from their eyes. Healthy volunteers aged 20–59 years ( n = 54) performed 81 exercises involving the localisation of a virtual hexagon’s vertices overlaid on a monitor surface. Nine predefined positions and three distances between the virtual hexagon and the users’ eyes (65, 85 and 105 cm) were set. We found that, some model positions and the shortest distance (65 cm) led to larger localisation errors than other positions and larger distances (85 and 105 cm). Positional errors of more than 5 mm and 1–5 mm margin errors were found in 29.8% and over 40% of cases, respectively. Strong outliers were also found (e.g. margin shrinkage of up to 17.4 mm in 4.3% of cases). The measured errors may result in poor outcomes of surgeries: e.g. incomplete tumour excision or inaccurate flap design, which can potentially lead to tumour recurrence and flap failure, respectively. Reducing localisation errors associated with arm reach distances between the virtual models and users’ eyes is necessary for augmented reality headsets to be suitable for surgical purposes. In addition, training surgeons on the use of these headsets may help to minimise localisation errors.

Background Finding enjoyable and effective long-term approaches to rehabilitation for improving the upper limb (UL) function of people with multiple sclerosis (MS) is challenging. Using virtual reality (VR) could be a solution to this challenge; however, there is a lack of reporting on the views of people with MS and clinicians on VR-based approaches and recommendations for games for rehabilitation. Objective This study aims to identify common UL problems and their related current therapeutic approaches for people with MS, and to explore the opinions of people with MS and specialist clinicians on VR and obtain suggestions for the development and design of VR games. Methods Separate focus groups were conducted with people with MS, recruited through the MS Society UK’s research network, and clinicians, recruited through the MS Trust Therapists in MS network. A total of 10 people with MS (2 focus groups) and 8 clinicians (5 physiotherapists, 2 occupational therapists, and 1 MS nurse in 2 focus groups) were involved. The focus groups were recorded and transcriptions were analyzed using theme-based content analysis. Results People with MS commonly reported that their UL problems interfered with activities of daily living and resulted in the loss of meaningful hobbies such as writing. Many people with MS neglected UL exercise and found strategies for adapting to the UL impairments. Similarly, clinicians stated UL rehabilitation was neglected within their service and that it was challenging to find interesting treatment strategies. VR was suggested by both participant groups as a solution, as it was convenient for people with MS to access and it could provide a more engaging and disguised approach to exercise. There were shared concerns with cybersickness and disengagement with using VR approaches. Both groups agreed games should be meaningful and adaptable for users but suggested different VR activities, with clinicians suggesting games directly reflecting activities of daily living and people with MS suggesting more abstract activities. Conclusions VR was well received by both people with MS and clinicians for UL rehabilitation. Recommendations were made for the development of VR rehabilitation games which are personalized and customizable for the varying abilities of people with MS.

Due to the COVID-19 pandemic the virus responsible, SARS-CoV-2, became a source of intense interest for non-expert audiences. The viral spike protein gained particular public interest as the main target for protective immune responses, including those elicited by vaccines. The rapid evolution of SARS-CoV-2 resulted in variations in the spike that enhanced transmissibility or weakened vaccine protection. This created new variants of concern (VOCs). The emergence of VOCs was studied using viral sequence data which was shared through portals such as the online Mutation Explorer of the COVID-19 Genomics UK consortium (COG-UK/ME). This was designed for an expert audience, but the information it contained could be of general interest if suitably communicated. Visualisations, interactivity and animation can improve engagement and understanding of molecular biology topics, and so we developed a graphical educational resource, the SARS-CoV-2 Spike Protein Mutation Explorer (SSPME), which used interactive 3D molecular models and animations to explain the molecular biology underpinning VOCs. User testing showed that the SSPME had better usability and improved participant knowledge confidence and knowledge acquisition compared to COG-UK/ME. This demonstrates how interactive visualisations can be used for effective molecular biology communication, as well as improving the public understanding of SARS-CoV-2 VOCs.

Introduction Anatomy is one of the many biomedical fields which has seen a surge in the popularity of technological advances in learning and teaching, especially during the Covid-19 pandemic. Augmented reality (AR), one of the most promising innovative technologies, has been applied to a variety of research areas, but little has been done in the field of neuroanatomy, one of the most challenging for students to study. However, there are still inconsistencies and disagreement between studies involving AR, highlighting current difficulties for the implementation of effective learning experiences. Integrating cognitive load theory (CLT), a psychological theory that explains how the brain processes new information to acquire knowledge, is one possible approach that could assist in the improvement of the adoption of this technology. Integrating CLT into the instructional design process could assist in avoiding improper instructional design, hence enhancing the learning efficiency. This study aimed to develop methodological framework guidelines for AR in conjunction with CLT, to address the challenges of neuroanatomical learning. Materials and Methods Using Unity, a leading game development platform, an AR neural pathway learning application was developed for Android operating system. This application was created in accordance with cognitive load reduction principles and was evaluated to develop the methodological framework. This study used quantitative methodology and a counter-balanced experimental design to compare the AR application to traditional teaching methods. Two learning modalities: the AR application, and a self-study PowerPoint presentation were assessed. 12 undergraduate medical and anatomy students from the University of Glasgow were randomly allocated to Group A (n = 6) or Group B (n = 6). Participants attended 2 learning sessions separated by 7-12 days. Group A used the AR application first, followed by traditional PowerPoint presentations in the second session to learn neuroanatomy. In contrast, Group B used the PowerPoint slides first and the AR application second. Participants completed a series of questionnaires before and after each session to assess the acquired neuroanatomy knowledge, cognitive load, usability and motivation. Results There was no significant difference between the two groups' baseline knowledge ( t (10)=1.000, p = 0.341). Paired-sample t-tests suggested that both learning resources promoted learning (group A, 1 st session t (5)=-2.390, p = 0.062, 2 nd session t (5)= -8.174, p < 0.001),(Group B, 1 st session t (5)= -2.697, p = 0.043, 2 nd session t (5)= -2.712, p = 0.042). When comparing the two groups using an independent-sample t-test, there was no significant difference between the two learning modalities (1st session t (10)=1.557, p = 0.15, 2nd session t (10)=1.655, p = 0.13). Regarding cognitive load, independent-sample t-tests indicated that neither intrinsic load (IL) nor extraneous load (EL) differed significantly between groups (IL t (10)=-.336, p = 0.74, EL t (10)=-1.833, p = 0.09), however, there was a trend towards reduced extraneous load when using the AR app. However, germane load, which is refer to the mental effort required to learn the new knowledge, was significantly lower when used the AR application (Group A M = 4.05, SD = 1.08, Group B M = 7.61, SD = 2.12, t (10)=-3.652, p = 0.004). Discussion and Conclusion These preliminary results suggest that, although there was no significant difference between the AR learning resource and the traditional learning method (PowerPoint) in promoting knowledge, learning via the AR app could lessen the mental effort required to study a complex subject such as neural pathways. To be more specific, because there was no significant difference in the amount of Intrinsic load (difficulty of the subject). Both, the AR app and the PowerPoint presented the same level of complexity for knowledge. Moreover, the AR app generated less extraneous load (mental demand generated by the design of learning resource), freeing up more working memory space for the germane load (mental effort required to learn new information). Consequently, the student can understand the information while spending less mental effort when using the app. The AR app also received a high usability score (SUS = 79.5), which also can be qualified as “excellent”. This study shows that implementing CLT into AR instructional design could benefit technologically enhanced instructions for anatomical education in the future. This study was conducted by the University of Glasgow and the School of Simulation and Visualisation at the Glasgow School of Art, with funding from the Faculty of Medicine Siriraj Hospital at Mahidol University